Bacillus cereus bacteremia outbreak due to contaminated hospital linens.

We describe an outbreak of Bacillus cereus bacteremia that occurred at Jichi Medical University Hospital in 2006. This study aimed to identify the source of this outbreak and to implement appropriate control measures. We reviewed the charts of patients with blood cultures positive for B. cereus, and investigated B. cereus contamination within the hospital environment. Genetic relationships among B. cereus isolates were analyzed. Eleven patients developed B. cereus bacteremia between January and August 2006. The hospital linens and the washing machine were highly contaminated with B. cereus, which was also isolated from the intravenous fluid. All of the contaminated linens were autoclaved, the washing machine was cleaned with a detergent, and hand hygiene was promoted among the hospital staff. The number of patients per month that developed new B. cereus bacteremia rapidly decreased after implementing these measures. The source of this outbreak was B. cereus contamination of hospital linens, and B. cereus was transmitted from the linens to patients via catheter infection. Our findings demonstrated that bacterial contamination of hospital linens can cause nosocomial bacteremia. Thus, blood cultures that are positive for B. cereus should not be regarded as false positives in the clinical setting.

Effect of heat treatment and enzymatic digestion on the B cell epitopes of cow's milk proteins.

BACKGROUND: Processing milk leads to changes in clinical allergenicity. However, the mechanism by which heat treatment affects the allergenicity of milk proteins is not fully understood. OBJECTIVE: We investigated the effect of heat treatment and enzymatic digestion on the allergenicity of B cell epitopes of milk proteins using a histamine release assay. METHODS: Human basophils were passively sensitized using sera from 10 patients with allergies to cow's milk. All the patients experienced symptoms immediately after ingesting milk. The human basophils were obtained from umbilical cord blood mononuclear cells after culturing the mononuclear cells for 3-4 weeks in the presence of IL-3. After sensitization with 10% patient sera for 48 h, the cells were stimulated with untreated, heat-treated, or heat-treated and pepsin-and-trypsin-digested beta-lactoglobulin or alpha-casein for 1 h. The histamine concentrations in the supernatants were then measured by radioimmunoassay. RESULTS: Heat treatment alone did not alter the molecular weight of beta-lactoglobulin or alpha-casein. Heat treatment of beta-lactoglobulin significantly increased its susceptibility to enzymatic digestion in a time- and temperature-dependent manner and reduced its ability to induce histamine release from sensitized basophils. Similar findings were not observed for alpha-casein. The combination of heat treatment and enzymatic digestion reduced the abilities of both beta-lactoglobulin and alpha-casein to induce histamine release from passively sensitized basophils. CONCLUSIONS: Heat treatment reduced the allergenicity of beta-lactoglobulin by inducing conformational changes and by increasing its susceptibility to enzymatic digestion, both of which disrupted B cell epitopes, whereas heat treatment alone did not alter the allergenicity of alpha-casein.

Dorsoradial avulsion of the triangular fibrocartilage complex with an avulsion fracture of the sigmoid notch of the radius.

We report two extremely rare cases of dorsal radial avulsion injury of the triangular fibrocartilage complex accompanied by an avulsion fracture of the sigmoid notch of the radius. Anatomical reduction of the bone fragment in conjunction with reattachment of the dorsal portion of the radioulnar ligament to the radial sigmoid notch were necessary to restore stability of the distal radioulnar joint and tension of the triangular fibrocartilage proper.

Irreducible palmar dislocation of the distal interphalangeal joint.

A case of a child with rare palmar dislocation of the ring finger distal interphalangeal joint requiring open reduction is presented and the literature discussed.

Diagnosis and monitoring of human cytomegalovirus diseases in patients with human immunodeficiency virus infection by use of a real-time PCR assay.

We used a real-time PCR assay to measure human cytomegalovirus (HCMV) DNA load in whole blood and plasma of 70 patients who were infected with human immunodeficiency virus type 1. Break points of 3.0 x 10(3) copies/mL in whole blood and 1.0 x 10(3) copies/mL in plasma were well-correlated with the existence of definite HCMV disease (sensitivity, 93% and 86%; specificity, 89% and 85%; positive predictive value, 70% and 63%; and negative predictive value, 98% and 95%, respectively). In patients with < 50 cells/microL of CD4(+) T lymphocytes, positive predictive values increased to 78% and 71%, respectively. The viral loads of all patients who received anti-HCMV therapy declined to < or =2.0 x 10(2) copies/mL in parallel with the improvement of clinical symptoms. These findings show that the HCMV DNA load quantified with our method is a useful tool for diagnosis of HCMV diseases and for monitoring the disease activity in patients infected with HIV-1.

Infantile autophagic vacuolar myopathy is distinct from Danon disease.

Lysosomal glycogen storage disease with normal acid maltase (Danon) is caused by primary lysosome-associated membrane protein-2 (LAMP-2) deficiency. Typically, the disease begins after the first decade; however, two infantile patients had similar histologic features. The infantile disorder is distinct from Danon disease, because, in both infants, LAMP-2 protein is present in skeletal muscle. Deposition of C5b-9 and multilayered basal lamina in one patient suggest that the infantile disease is pathogenically similar to X-linked myopathy with excessive autophagy.

Intractable Q fever treated with recombinant gamma interferon.

A 3-year-old boy with Q fever received several kinds of antibiotics including minocycline, but spiking fever and positive PCR of Coxiella burnetii continued for several months. He became asymptomatic and his abnormal laboratory data normalized after the administration of gamma interferon three times a week.

Regeneration process of mechanoreceptors in the reconstructed anterior cruciate ligament.

We performed reconstructive surgery on the anterior cruciate ligament (ACL) of the rabbit using a free bone-patellar tendon-bone (BTB) graft and evaluated nerve regeneration in the graft. The right ACL of 15 Japanese white rabbits was resected and reconstructed using a BTB graft. The BTB and ACL from the contralateral knee served as controls. The graft and control BTB were collected at 2, 4, and 8 weeks after the operation. We measured the number of mechanoreceptors in the ligaments using a modified gold chloride method. In the control patellar tendon, mechanoreceptors were present in all the samples. At 2 weeks after the operation, mechanoreceptors were not observed in the reconstructed ligaments. They were observed at 4 weeks but in lower numbers than in the control knees. At 8 weeks, the total number of mechanoreceptors did not differ significantly in the reconstructed and control tendons. The appearance of mechanoreceptors in the graft between 2 and 4 weeks postoperatively suggests that regeneration of mechanoreceptors occurred during this time period. At 4 and 8 weeks postoperatively, there was no significant difference in the number of mechanoreceptors between the intra-articular portion of grafted tendon and the contralateral ACL. The further increase between 4 and 8 weeks to control levels suggests that this regeneration may restore mechanoreceptors in BTB grafts to normal levels.

Coronary artery bypass grafting in a patient with human immunodeficiency virus: role of perioperative active anti-retroviral therapy.

In a patient with severe ischemic heart disease and advanced human immunodeficiency virus (HIV) infection, vigorous perioperative treatment with anti-retroviral agents was given and coronary artery bypass surgery using cardiopulmonary bypass was successfully performed. This strategy could become the standard for patients with cardiovascular disease and advanced HIV infection. The following aspects of this case require further investigation: (1) lack of a reactive increase in the neutrophil count, (2) transient extreme reduction of lymphocytes, and (3) a relative decrease in the CD8+ cell ratio.

A study of mechanoreceptors in fibrocartilage masses in the defect of pars interarticularis.

We investigated the origin of low back pain associated with lumbar spondylolysis and spondylolytic spondylolisthesis by removing fibrocartilage masses from the lytic sites in symptomatic patients and staining the masses by the Gairns gold chloride method to examine mechanoreceptors. The fibrocartilage masses were found to contain four types of mechanoreceptors: Pacinian corpuscles, Ruffini receptors, Golgi tendon organ-like receptors, and free nerve endings. All of these mechanoreceptors were present at the periphery of the specimens, and Ruffini receptors and free nerve endings were abundant. Some mechanoreceptors had a slightly atypical structure, in addition to those with typical morphology. Comparison with mechanoreceptors in normal lumbar facet joint capsules showed that there were more mechanoreceptors in the fibrocartilage masses and a greater proportion of atypical structures at lytic sites. The presence of mechanoreceptors at lytic sites suggests that the fibrocartilage masses are not simply scar tissue filling the defect. Rather, these masses also appear to play a protective role by sensing instability via mechanoreceptors and transmitting this information as pain, while at the same time acting as ligament-like tissue that connects and stabilizes the separated vertebral arches.

Lysosomal glycogen storage disease with normal acid maltase with early fatal outcome.

In a male infant who had cardiomyopathy, generalized muscle weakness and increased serum creatine kinase levels, his muscle biopsy revealed myopathic changes with tiny intracytoplasmic vacuoles containing PAS-positive material and high acid phosphatase activity, but had normal acid maltase activity biochemically. These findings were consistent with those seen in lysosomal glycogen storage disease with normal acid maltase (Danon disease). Sarcolemmal indentations commonly seen in this disease were missing, but a complement membrane attack complex, C5b-9 was positive along the surface membrane of the muscle fibers as seen in X-linked vacuolar myopathy. The patient was on a respirator and died at 27 months of age from pneumonia and hypertrophic cardiomyopathy. Lysosomal glycogen storage disease with normal acid maltase may be manifested at birth with marked skeletal and cardiac involvement leading to death in early infancy.

Morphological study of mechanoreceptors on the coracoacromial ligament.

We performed gold chloride staining of coracoacromial ligaments removed at operation, observed the peripheral nerve endings in the ligament, and studied their distribution and changes with aging in order to clarify the proprioception of the shoulder joint. The coracoacromial ligament was found to contain four types of typical nerve endings: Pacinian corpuscles, Ruffini receptors, Golgi tendon organ-like receptors, and free nerve endings. In addition, non-typical Pacinian corpuscles and Ruffini receptors with non-typical morphology were present. There were also unclassifiable nerve endings with a morphology which did not fit any of the above categories. These typical, non-typical, and unclassifiable nerve endings were all widely distributed on the surface of the subacromial side at the insertion into the acromion and around the coracoid process in the ligament. Free nerve endings were found sporadically on the surface of the subacromial bursal side in the ligament. The resected coracoacromial ligaments (23 specimens) were divided into two groups based on the disorder that required surgery: a fracture group without subacromial impingement (5 specimens) and a group with subacromial impingement (18 specimens). Age-related changes in the number of nerve endings were compared in each group. The total number of nerve endings decreased with age in both groups. The number of Pacinian corpuscles, Ruffini receptors, Golgi tendon organ-like receptors, and free nerve endings of typical morphology tended to decrease with age. The data from the fracture and subacromial impingement groups were not analyzed statistically because of the difference in the number of specimens in each group. However, the total number of nerve endings was lower in the subacromial impingement group than in the fracture group at all ages. The typical nerve endings of the coracoacromial ligament in both groups tended to decrease in the elderly, suggesting that the proprioception of the shoulder joint may become impaired with aging.

Antimicrobial effects of electrolytic products of sodium chloride--comparative evaluation with sodium hypochlorite solution and efficacy in handwashing.

We examined the in vitro bactericidal effects and efficacy on handwashing of water containing electrolytic products of sodium chloride (electrolytic water). The electrolytic water, whose pH and concentration of free residual chlorine were 6.7-6.9 and 20-22 ppm, respectively, showed equal reduction of both Staphylococcus aureus and Escherichia coli to dilution of commercially available sodium hypochlorite containing 60 ppm of free residual chlorine. This bactericidal effect was calculated to be due to hypochlorous acid, based on the pH and the amount of chlorine in solution. Handwashing with the electrolytic water reduced the numbers of S. aureus on hands by 1/10(2), while running water and 0.2% benzalkonium chloride with 80% ethanol gave a 1/10 and 1/10(5) reduction, respectively. We conclude that electrolytic water might be applicable for handwashing in place of running water.

Mechanoreceptors of patellar tendon used for ACL reconstruction. Rabbit experiments.

In 17 Japanese white rabbits (weighing 2.6-3.7 kg), the anterior cruciate ligament of the right knee was resected and then reconstructed, using the lateral half of the patellar tendon. The contralateral side served as control. Rabbits were killed 10, 20, or 30 weeks postoperatively. Then the reconstructed ligament was harvested and stained, using a modified gold chloride method. Under the light microscope, sensory nerve endings in serial sections were counted after being morphologically identified. With respect to the number of Pacinian and Ruffini corpuscles, there were no significant differences between the reconstructed ligament and the control patellar tendon at any time after surgery.